1. Field of the Invention
The present invention relates generally to the structure and use of surgical instruments, and more particularly to a method and apparatus for manipulating and dissecting body structures during surgical procedures.
Minimally invasive surgical (MIS) techniques, such as laparoscopic, endoscopic, and arthroscopic surgery, are generally performed through small incisions using specialized instruments to accomplish the desired surgical procedure. Usually, the instruments are introduced through a narrow-diameter tube, such as a trocar sleeve, while the physician observes manipulation of the instruments through specialized imaging equipment, such as laparoscopes, endoscopes, and arthroscopes. Such MIS techniques offer significant advantages over conventional "open" surgical procedures. In particular, the MIS techniques are usually less traumatic, require a shorter recovery time, and are less costly than corresponding conventional surgical procedures.
Of particular interest to the present invention are laparoscopic cholecystectomy procedures where the gallbladder is surgically severed (commonly referred to as dissected) and withdrawn through a small trocar sleeve, typically having a diameter of about 10 mm. In order to manipulate the gallbladder, several grasping forceps are introduced through additional trocar sheaths, and the position of the gallbladder is constantly changed in order to expose the interface between the gallbladder and surrounding tissue, particularly the liver, to permit dissection. The actual dissection has usually been performed using forceps, hooks, and/or a small gauze pledget to tear and tease the gallbladder from the surrounding tissue along the dissection plane.
While laparoscopic cholecystectomy procedures have been very successful and have become increasingly common, the need to simultaneously handle multiple graspers as well as a dissection instrument places great demands on the physician and usually requires coordination with one or more surgical assistants. The difficulty in performing the procedure is exacerbated by the slickness of the gallbladder surface, and overly vigorous attempts to capture the gallbladder can result in perforation, bile spillage, and gallbladder collapse. A collapsed gallbladder is even more difficult to dissect from the surrounding tissue than an intact gallbladder.
For these reasons, it would be desirable to provide improved methods and apparatus for manipulating and dissecting gallbladders during laparoscopic cholecystectomy procedures. It would be particularly desirable if such methods and apparatus were suitable for performing manipulation and dissection of other body structures during other surgical procedures. The method and apparatus should provide for controlled movement and manipulation of the body structure, preferably using a single instrument that can be manipulated by the physician with one hand. In the case of the gallbladder, the instrument should minimize the likelihood of bile spillage and should assure that the gallbladder remains expanded, preferably distended, to better present the dissection plane during the procedure. The method and apparatus should further provide for improved dissection techniques with reduced bleeding and tearing of the gallbladder, optionally providing for electrocautery capabilities.
2. Description of the Background Art
U.S. Pat. No. 4,430,076, describes a device for manipulating the uterus during examination procedures. The device is a handle having a balloon at its end, where the balloon is introduced through the cervix, inflated, and the handle is used to manipulate the uterus for examination purposes. Pietrafitta et al. (1991) Gastrointestinal Endoscopy 37:338-343, discloses the use of a dilating balloon to distend the pylorus during laparoscopic pyloromyotomy.